In the U.S., modern antiretroviral (ARV) therapy has transformed HIV infection from a terminal illness to a chronic infection with a potentially normal life span. With long life-spans, alcohol use has a greater opportunity to play an important role in the progression of HIV disease through effects on utilization of antiretroviral (ARV) therapy, immune recovery and the development of AIDS-related and non-AIDS related clinical events. Hazardous alcohol use is associated with a wide range of adverse health effects. In HIV-infection, we have shown that hazardous drinking (NIAAA definition) is associated independently with diminished utilization of ARVs, and poorer HIV viral load suppression and immune recovery. Since hazardous alcohol use interferes with effective ARV treatment, it is therefore likely that it will be associated with more rapid HIV disease progression. However, because HIV infection is characterized by chronic inflammation and immunocompromise, co-infections such as viral hepatitis, and possibly an increased risk of non-AIDS related clinical events (e.g. cardiovascular, renal, liver, endocrine), even lower levels of alcohol use that are not generally considered hazardous may have an adverse impact on patients with HIV-infection. Therefore, we propose to determine the relationship of alcohol use more broadly on HIV treatment and clinical disease progression. Our research will use the Johns Hopkins HIV Clinical Cohort, a longitudinal clinical cohort of patients who receive primary HIV/AIDS care on the Johns Hopkins HIV/AIDS Services. The Cohort was established in 1991, and has provided a rich source of data for over 160 papers that have examined the natural history, treatment and outcomes of HIV infection in patients in care. We assess specific levels of alcohol consumption using more than one validated consumption questionnaire, as well as drinking-related problems every 6 months with an audio computer-assisted self-interview (A-CASI). We propose to address the following specific aims: 1) Evaluate the relationship between alcohol consumption and response to HIV treatment (virologic and immunologic response, development of HIV resistance mutations, development of opportunistic infections, and survival), 2) Evaluate the relationship between alcohol use and development of toxicity from antiretroviral therapy. Alcohol use at levels generally considered non-hazardous may be a significant under- recognized barrier to the effective long-term management and outcomes of HIV infection. Our research can yield valuable results to better understand the relationship between alcohol use and HIV/AIDS. PUBLIC HEALTH RELEVANCE: Modern HIV therapy is allowing people with HIV infection to live longer lives. Because of this, alcohol drinking may have a greater opportunity to cause adverse consequences. Our study is designed to measure alcohol use in a population of HIV- infected patients in care, and to determine levels of alcohol use that increase the risk of bad outcomes.